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HomeMy Public PortalAbout5819 GOLDEN WEST AVE_Building__ VISION OF BUILDING AND SAFETY ® � ® � =.• Department of County Engineer NG County of Los Angeles WM. J. FOX, COUNTY ENGINEER __ APPLICATION _ FOR APPLICANT 17FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK./OR�yREc.NO. PERMIT NO. BUILDANG EI DDSS R15CEJVED BY DATE OFAPPL. DATEISSUED LOCALITY - NEAREST CROSB ST. BUILDING ADDRESS OWNER MAILZ 00LOCALITY �,�y✓•, ppp ADDRESS NEAREST CROSS ST. �Q.r.�✓`v�`Lr'�.. ' RO ARCHITECT O , NO. ZONE I PLANS I TYPE C-'-lI_V6Ud� � ENGINEER BLDG. ORD. NO. \ SETBACK LINE ADDRESS ��' � -4k%��" _ UBE APPROVEDr� CONT S ZONE BY _ DATE?' c� HOUSE NUMBERING ADejEr MAP NUMBER _ 145 NO. ASSIGNED BY LEGAL CORRECTIONS DESCRIPTION LOT NO./ BLOCK ' TRACT NO. OF BLDGS. SIZE OF LOT NOW ON LOT ' USE OFI NO.OF EXISTING BLD FAMILIED ESCRIPTION OF WORK 00 O NEW ALTERATION ADDITION Z D REPAIR DEMOLITION r SQ. FT. NO.OF SIZE ROOMS STORIES _ EXT.WALL I ROOF COVERING COVE NG USE OF STRUCTURE INSPECTION _zz9ff OCCUPANCY ASR APPROVALSOJflS SIGNATURE DATE FOUNDATION: LDCATION (/,( FORMS, MATERIALS � jAbs /7 Sys I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN IS FRAME: FIRE STOPS; CORRECT. BRACING, BOLTS 1 AGREENW.CO Y WITH ALL COUNTY ORDINANCES AND STATE RE ULAT NG BUILDING CONST CTION. FURNACE: LOCATION, GAS VENT, DUCTS SIGNATURE O LATH, INT. PERMITTEE _ EXT. ADDRE33 �- PLASTER, INT. AUTHORIZED AGT. $ PLABTER, EXT. P.C.ffi ,�� FEE a �-- HOUSE NUMBER COR- RECT AND POSTED VALUATION 5:1 FEE ® FINAL �� ., , „�, I e-D 76AS38A DBS 3 I-S2 WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING " P E RM I T insure, or a certificate of Workers'Compenstion Insurance, or a-certified-copy thereof(Sec. 3800, Lob. C..)_. - --- - - - - - COUNT-Y-OF-LOS ANGEL-ES -- =- - BUILDING AND SAFETY__ Policy No. Company BUILDING --�+, C/Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS d 6O � ElCertified copy is filed with the county building inspec- BUILDING �/ / Tion department. ADDRESS ( �V W LOCALITY ,e— C / NEAREST � C Date Applicant CITY, /1� (,. a[ ZIP CROSS ST. L1�� fP' CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONEMAP O hundred dollars ($100)or less.) TRACT BLOCK LOT NO. / NO. TEL. '��J Cv �/ SPECIAL I certify that in the performance of the work for which this OWNER /L� NO.- J�� CONDITIONS permit is issued, I shall not employ any person in any manner y /Q / _��o j - DISTRICT GROUP TYPE FIRE PROC SED BY- u ADDRESS v �C h GVL— k, CONST. ZONE so as to become subject to the Wor ers'Compensation Laws. �_ 7 4---- / 1� ApplicantffiCITY ZIP STATISTICAL CLASSIFICATION APT. CONDO. ARCHITECT OR TEL. NOTICE TO APPLICANT: If, of r making this Certificate of AZ/ 451 Exemption, you should become subject to the WorkersENGINEER NO. CLASS NO. DWELL. UNITS 9L Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be _ deemed revoked. CONTRACTOR ��,�aJ�-- NO. BK.�PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. / OA Professions Code,.and my license is in full force and effect. CITY CLASS $ d SQ. FT. NO. OFNO. OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE ContractorDate DESCRIPTION OF WORK R(�� NEW I om exempt from the licensing requirements as I am a C, tco� ADD licensed architect or a registered professional engineer �� ,yALTER FINAL � K acting in my professional capacity (Section 7051, +H' � o 4 (�j�aLDb" REPAIR DATE Business and Professions Code). USE OFFINAL EXISTING BLD S DEMOL By V ' Lic.or Reg. No. Date APPLICANT r TEL.;2 +?J OWNER-BUILDER DECLARATION, (PRINT) o.a� NO. O J� I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS is Professions Code): PRESENTBUILDING z—�y /El I, as owner of the property, or my employees with ADDRESS wages as Their sole compensation,will do the work and LADDRE Y (A hi C�C) Yer k the structure is not intended or offered.for sale(Section 7044, Business and Professions Code). G ••TEL. z 0 7 1,2 A I, as owner of the property, am exclusively contracting ACTOR NO. with licensed contractors to construct the project (Sec- S 00 0 0 0tion 7044, Business and Professions Code). IRED TOTAL SETBACK FROM EXIST. .CONSTRUCTION LENDING AGENCY ACK YARD HWY PROP. LINE WIDTH 2'0'0 3 4,00 1 hereby affirm that there is a construction lending agency for Ttheperformance of the work for which this permit is issued 0'0 0 3:4, 0 0 (Sec. 3097, Civ: C.). OLender's Name Lender's Address e$ Permit Fee 1 certify that I have read this application and state that theIssuance Fee above information is correct. I agree to comply with all County ation Fee 0 ordinances and State laws relating to building construction, Total Fee and h by authorize,representatives of this County to enter V a upo t e abov mentioned roperty for inspection purposes. , a SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Dote ©s APPLICATION FOR BUILDING PERMIT � COUNTY OF LOS ANGELES BUILDING AND SAFETY = WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADD BU I I AD RESS I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or a certified SPY thereof(Sec.3800:Lab.C.) CITY Z115 j LOCALITY Policy No. Company SIZE OF LOT 27!4 [ NO.OF BLDGS.NOW ON 7000 - ❑ Certified copy is hereby furnished. n �O - S�t• _ Twoe,,,..c g 140: o NEAREST CROSS ST ❑ Certified copy is filed with the county building inspection TR% (01 BL L O. USE ZONE MAP NO. department. Date Applicant AS FOIA BOOK �G€ ARCE L �—/ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' ,09 OWNER 'v �i TEL.N / �� VES G o COMPENSATION INSURANCE L N � � �G�&E- ze? WITHIN 1000 FT.OF SCHOOL? AD RES '/ (This section need not be completed if the permit is for one hundred ` N /DD DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) I certify that in the performance of the work for which this permit C fD ZIP ��O o-._� �_-5 is issued, I shall not employ any person in any manner so as to ARCHITE OR ENGINEER TEL.NO. �� //ls� become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL.NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS SIDE OV PL I hereby affirm that I am licensed under provisions of Chapter 9 SQ.FT SIZE NO. STORES NO. FAMILIES SEWER MAP (commencing with Section 7000)of Division 3 of the Business and NEW ❑ BK PG O Professions Code,and my license is in full force and effect. v xD SCRIPTION OF WORK ADD ❑ VALUATION License Number Lic.Class O N Contractor Date ALTER ❑ t z_ El am exempt under Sec. (ex(S T1,4 REPAIR 11 B.&P.C.for this reason DEMOL ❑ LOMA P/C# Date: USE OF EXISTING BLDG. URM, ❑ A Signature APPLI ANT(PRINT) �,7l� TEL.NO. LDMA Perm# a CTr Ll�ib~/V/ !/moi Z "''.'f as owner of the property, or my employees with wages as p AC L ra Alheir sole compensation,will do the work and the structure is AbI5RESS not intended or offered for sale (Section 7044, Business and J-6 Q i?fl s /�, FINNA�L DATE Q -n-Professions Code.) „(�r—� W L THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDO L v_ _J O A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER T AN ❑ 1, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL ;VES❑ 7A–A[ a 1 licensed contractors to construct the project.(Section 7044, NO❑ 1'-!'3� 0 35-3, Business and Professions Code.) _ WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING ���j"I1>?. OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _ CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST S, 21" zi„II FOR GUIDELINES. , I hereby affirm that there is a construction lending agency for YES❑ No❑ the performance of the work for which this permit is issued(.Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES ! l,;j;i '-' ?•jl,j j_ ;' jj'i1i_: m. COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. '? 1 i a Lender's Address J't+� i�"` i0 OWNER OR AGENT . o' 1 certify that I have read this application and state that the above EE PERMIT FEEF information is correct. I agree to comply with all county P.C. $$ ordinances and State laws relating to building construction,and e� a. hereby uthorize represen ves of this County to enter upon ISSUANCE FEE the ve- ioned pro y for inspection purposes. INVESTIGATION FEE TOTAL FEE iy nt rn'ApwT / Deb . fT ��iv ) SEE REVERSE FOR EXPLANATORY LANGUAGE t • APPLICATION FOR BUILDING PERMIT --- - - - - ---- - - - --- -- --- - - -------COUNTY_OF-LOS--ANGELES.-------- -- --------------BUILDING AND..SAFETY - - - • WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS 0 we a certificate of Workers' Compensation Insurance, or a certified 56 Iq copy thereof(Sec.3800, Lab. C.) CITY ZIP Q Ie �q l 42 LOCALITY . Policy No. Company SIZE OF LCT NO,OF BLDGS.NO ON LOT ❑ Certified Copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER UTEL NO, COMPENSATION INSURANCE (41 /1 ' WITHIN 1000 FT.OF SCHOOL. YES No (This section need not be completed if the permit is for one hundred ADDRESS dollars ($100)or less.) u •-rye S -PR- DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY CITY ZIP n 1 certify that in the performance of the work for which this permit r . ( 6,0 D fl K /(M6�/�^ is issued, I Shall not employ any person in any manner So as t0 ARCHITECT ORE ENGINEER TEL O. UI become subject t0 the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS - .1 CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of •�4 or "� cck. ` 3-3 REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become subject to the Workers CONTRACTOF1 TEL NO ISET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ' ZFRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC. O. P L LICENSED CONTRACTORS DECLARATION O SIDE CITY yIC. AS .P L I hereby affirm that I am licensed underprovisions Of Chapter 9 SEWER MAP >_ (commencing with Section 7000)of,Division 3 of the Business and SO.FT.�IZE NO.OF STORIES NO.OF FAMILIES I1. Professions Code,and my license is in full force and effect. 2.S 1 1 NEW ❑ BK PG O License Number Gr11]2j DESCRIPTION OF WORK VALUATION , V rY Lic.Class \ ADD Contractor Date ALTER $ 5000. cc ❑ REPAIR I— yy�� -• •�I am exempt under Sec. P B.&P.C.for this reason DEMOL ❑ LDMA P/C# _.�f �;- ..,.... _I=.'f_` W a Date: 11U �nT�Q� USE OF,E ISTING BLDG. URM,aa ❑ �� - V� Vx tm _.�K�' B _.�p: Mi Signature APPLICANT(PRINT) TEL NO. LDMA Perm# = Z El 1, as owner of ing the property, or my e loyees with wages asz OT 0. - - .-. . .€-�Llr^-•e•:_...... their sole compensation, will do the work and the structure is ADDRESS � _p,E,+,f-; '�'°_°,�•I not intended Or Offered for sale (Section 7044, Business and FINAL D TE Uv q� a _•fir.. Professions Code.) �� 11 =• sbit1 p_ WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ��✓✓ ❑ 1, as owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Oy J AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY "<�T''.. ." �>,licensed contractors to construct the project (Section 7044, YEs❑ NO❑ 1. € I "€' ice.,�)-if_f•-I'€IU ..Ji ._ Business and Professions Code.) � �. .��;:.. _ WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ���}i'i S� "' j• {,A.f; T e+i•-�• CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ NO❑ a the performance of the work for which this permit is issued(Sec. r:="'°7 s (f 3097,CIV. C. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING t'•`^'�'• sT'' ) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, N _ ................ .. _. .-y. TITLE 2,CHAPTER 220 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. 0- Lender's Address _ sµ O OWNER OR AGENT ' o I certify that I have read this application and state under penalty j€t? ;� 166 m $.1 8 O of perjury that the above information is correct. I agree to comply P.C.FEE D PERMIT FEE A _ with all county ordinances and State laws relating to building ©� t`• t_,f-E' K 1 J;:S ;;_, < construction, and h authorize representatives of this County ISSUANCE FE _ ,.._ I N '- ... to enter upon th ve mentioned property for inspection purposes. , -HRa .3� O INVESTIGATION FEE TOTAL FEE i+� .D of Date ( SEE REVERSE FOR EXPLANATORY LANGUAGE 'els_�I_j APPLICATION FOR BUILDING PERMIT COUNTY OF-LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN s BUI LN©G ADDRESS I hereby affirm that l have a certificate of consent to self insure, BUILDING ADD ESS or a certificate of Workers' Compensation Insurance,or a certified 53 61)114f-)I copy thereof (Sec. 3800,Lab.C.) CITY f zIP LOCALITY Policy No. Company SIZE OF LIDT NO.OF BLDGS.NOW ON LOT El Certified CROSS S Certified copy is hereby furnished. - ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAE OLS PAGE s PARCEL 0 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. YES NO COMPENSATION INSURANCE WITHIN 1000 FT.of SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS �/ � DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100) or less.) I certify that in the performance of the work for which this permit CITY t� Z'�A T( -7 3`0 is issued, I shall not employ any person in any manner so as to AR HITECT OR ENGINEER _J TEL NO. �J L/ ✓i�S become subject to the Workers'Compensation Laws. _ STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. 0-Z DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you spould, become subject to the Workers' CONTR CTOR �' �K) TEL NO. SET BACK YARD .HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith t I FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LJC NO. P L 71e 1q LICENSED CONTRACTORS DECLARATION � SIDE CITY- - _ LIC.CLASS P L 1 hereby affirm that I am licensed underprovisions of Chapter 9 F SEWER MAP (commencing with Section 7000)of Division 3 Of the Business and ,SQ.FT IZE F STORIES NO.OF FAMILIES Professions Code,and my license is in'full force and effect. / NEW El BK PG , d License Number J Lic. Class !J DESCRIPTIOIOF WORK I ADD PQ VALUATION Q Contractor DateMLCA' ALTER El � ���' ❑ 1 am exempt under Sec. REPAIR 1-1 $ B.&P.C. for this reason DEMOL ❑ V LDMA P/C# [LI Date: USE OF EXISTING BLDG. URM ❑ w a- i•f� Signature APPLICANT(PRINT) TEL NO_. LDMA Perm# r z ass;'•� GPci Z y 'v"t•_t•t a S' ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is ADDRESS { _ ;_• 0 s ;d not intended or offered for sale (Section 7044, Business and O FINAL D Q V �_ ��+ ' PFOfeSSlOnS Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HA DOUS MATERIAL il} .� }�_}:'i�.i OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J El I, as owner of the property, am exclusively contracting AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY j �F i I { licensed contractors to construct the project (Section 704444,, YES❑ No❑ ` Business and Professions Code. TO TAI = 73 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH •�r}}}--•a j' CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR `}:. • GUIDELINES. } t•• i _ I hereby affirm that there is a construction lending agency for YES❑ No❑ (•fhi;If_ r I_f} cel the performance Of the Work for which this permit IS ISSUed(SBC. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING _ 3097, Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, N TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. 0 0i 0—'j;Jj 11 }/ti0/ o Lender's Address OWNER OR AGENT -1. fY o I certify that I have read this application and state under penalty of perjury that the above information is correct. I agree to comply P.C.FEE ✓O o PERMIT FEE o with all county ordinances and State laws relating to building ! . construction, and hereby authorJize representatives of this Count ISSUANCE FEE co to enter upon the above me i6ned r er4y for inspection purposes (O Qc D �•—,3°--C�j INVESTIGATION FEE TOTAL FEE of Applicant pr Age Date SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS �p ,r1p or a certificate of Workers' Compensation Insurance,or a certified `-� 0 • k copy thereof (Sec.3800, Lab.C.) CITAD Lo ZIP G• LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NO ON OT ❑ NEAREST CROSS T.Certified copy is hereby furnished. _ ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR,M�P 40S�K PAGE PARCEL G6 " r ECIAL CONDITIONS �� a/ CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER T L NO. COMPENSATION INSURANCE ( 30 WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be.completed if the permit is for one hundred ADDRESS DISTRICT GROUP TCONST. FIRE ZONE PROCESSED BY dollars ($100) or less.) CITY ZIP I certify that in the performance of the work for which this permitoe ,r is issued, I shall not employ any person in any manner so as to c / G J become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLgSSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become subject t0 the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (Commencing with Section 7000)of Division 3 of the Business and SQ�FT.,SIko N0.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. /V GS NEW ❑ BK PG DESCRIPTIO OF WORK VALUATION a License Number Lic.Class ADD � 0 Contractor Date /O ALTER ❑ $ �� U Cie V� ' ZLo cc El am exempt under Sec. REPAIR ❑ $ 0 BAP.C. for this reason DEMOL ❑ 3=.A 50.50 W LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ - Q. Signature APPLICANT(PRINT) TEL NO. LDMA Perm# - z Sk4, as owner of the property, or my employees with wages as Z their sole compensation, will do the work and the structure is ADDRESS not intended or offered-for sale (Section 7044, Business and FINAL DATE� 0 ACCT a Professions Code.) (/(,e, I • g WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ I, as owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING-A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ((�I•� j'y AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 3303 142 o ill licensed contractors to construct the project (Section 7044, YES El No El Business and Professions Code.) 7 ITEMS WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH TOTAL 192 - 70 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCACMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES E] No❑ CHECK 192.70 N the performance of the work for which this permit is issued(Sec. CHANGE .�} p1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,CIV.C.) CHECKLIST,I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2,CHAPTER 2.20•SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. nrt n n Q_ Lender's Address OWNER oa nceNr O 0000--0001 1/16/96 0 o I certify that I have read this application and state under penalty / Dpt ell L, o 00 of perjury that the above information is correct.I agree to comply P.C.FEED. PERMIT FEE Y2C�O 1 fel 1 (]• 7 N with all county ordinances d State laws relating to building m construction, and hereby au rize representatives of this County ISSUANCE FEE a 7 30 0 to enter upon the abov me operty for inspection purposes. nINVESTIGATION FEE TOTAL FEE �1. m OS a; . 7 $ipn¢Nr¢pl Applicant or Del¢ SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 .0305230031 PHONE: (626) 285-0488 EXT: LEGAL D: NO. OF CONST BUILDING-ADDRESS: TR: 6561 LT: 469 SQ. FT STORIES TYPE 5819 GOLDEN WEST AV STRUCTURE: VN TEMP CA 917802204 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 8587-024-004 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: RESID USE ZORYT-R-1 ISSUED ON: PROCESSED BY: EXPIRES N: EXIST OCC GRP: 05/23/03 JK 05/17/04 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: XUE PEI HU AND SHUN QING LIU (626) 379-9770- 500 5819 GOLDEN WEST AV ( � TEMP 917802204 FEES PAID DESCRIPTION OF WORK REPLACE 2 WINDOWS AND FRONT DOOR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. 96. SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 500.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC 500.00 VAL 43.65 TOTAL FEES 71.90 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 150H269 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: (NI M� �S FRONT PL- (a` E'er �"I' �� INSULATION/WEATHER STRIP SIDE PL- (s'L iZAo. �o alc3i" � ` INTERIOR LATH/DRYWALL EXTERIOR LATH wry Z RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES TED SHAFTS/OPENINGS -BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508